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32 3 Introducing Blue Marble Health The framework of the NTDs first emerged following the launch of the UN’s Millennial Development Goals. In 2005, tackling the NTDs was very much framed as a pro-­ poor strategy that targeted sub-­ Saharan Africa, and our original list of 13 diseases was based on the major NTDs affecting the African continent (box 3.1) [1]. But even then we recognized that NTDs were worldwide and important public health and economic problems of South and Southeast Asia, as well as the poorest countries of the Americas, including Bolivia, Guyana, Haiti, and in Central America, Guatemala, Honduras , and Nicaragua. After first moving to Texas in 2011, I began to think about NTDs differently . Although we called them neglected tropical diseases, I found that the tropical component might be less important than the social determinants that give rise to these conditions. Instead, I came to realize that poverty was the overriding determinant engendering the NTDs. These diseases were found only in the setting of extreme poverty, but they also reinforce poverty through specific mechanisms: the NTDs interfere with worker productivity, child development , and women’s health; they also can be highly stigmatizing. The link between disease and a social determinant such as poverty had been highlighted before by Jeffrey Sachs, as well as by Dean Jamison and his colleagues in their landmark 1993 World Bank document—the World Development Report—that linked investments in health to economic returns on investment [2], and by the writings of Sir Michael Marmot in London on social determinants of health inequalities [3]. Hotez.indb 32 6/22/16 11:02 AM Introducing Blue Marble Health 33 Driving through the poorest parts of Houston and elsewhere in Texas was a stark wake-­up call that poverty was not unique to sub-­ Saharan Africa, or Asia, or even just the most destitute countries in Central and South America . Extreme poverty can be found even among the wealthiest economies, but the character of poverty in wealthy countries is unique. Unlike the poorest countries of Africa, or in Haiti, where poverty is almost universal, in wealthy countries poverty concentrates intensely in large pockets. The way I began to look at poverty amidst wealth as it pertained to NTDs was to focus first on the Group of 20 (G20) economies. The G20 includes the European Union and 19 of the largest economies, led by the United States and followed by China, Japan, and Germany. The G20 was organized in 1999 in order to facilitate cooperation and communication following the Asian financial crisis, with its first summit held in 2008 during the global financial Box 3.1. The Original List of 13 Neglected Tropical Diseases in Africa and Their Major Etiologic Agents Protozoan Infections African trypanosomiasis Trypanosoma gambiense, T. rhodesiense Kala-­ azar (visceral leishmaniasis) Leishmania donovani Helminth Infections STH Infections Ascariasis Ascaris lumbricoides Trichuriasis Trichuris trichiura Hookworm infection Necator americanus Schistosomiasis Urinary schistosomiasis Schistosoma haematobium Hepatobiliary schistosomiasis S. mansoni Lymphatic filariasis Wuchereria bancrofti Onchocerciasis Onchocerca volvulus Dracunculiasis Dracunculus medinensis Bacterial Infections Trachoma Chlamydia trachomitis Leprosy Mycobacterium leprae Buruli ulcer Mycobacterium ulcerans Hotez.indb 33 6/22/16 11:02 AM 34 Blue Marble Health crisis in that year [4]. I am captivated by the G20 because it boasts such enormous fiscal horsepower, with the capacity to introduce trillions of dollars in economic stimulus packages [4]. No other organization rivals it in terms of its ability to effect global change. Shown in table 3.1 is a summary of the most recent economic indicators for the G20 countries, to which I have added the nation of Nigeria [5–8]. Table 3.1. Updated economic indicators for the G20 nations and Nigeria Country GDP rank 2014 GDP (in trillions of US$) Population rank European Union 1 18.46 Not determined United States 2 17.42 3 China 3 10.36 1 Japan 4 4.60 10 Germany 5 3.85 16 United Kingdom 6 2.94 22 France 7 2.83 21 Brazil 8 2.35 5 Italy 9 2.14 23 India 10 2.07 2 Russia 11 1.86 9 Canada 12 1.79 37 Australia 13 1.45 51 South Korea 15 1.41 27 Mexico 16 1.28 11 Indonesia 17 0.89 4 Turkey 19 0.80 18 Saudi Arabia 20 0.75 44 Nigeria 23 0.57 7 Argentina 25 0.54 32 South Africa 34 0.35 25 All G20 countries + Nigeria 66.95a Global 77.89 % in G20 + Nigeria...


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